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General NPI Number Information
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NPI Number | 1548240765
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Entity Type | Individual
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Provider Name | SUBRATO JESSE DEB MD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1301 PALM AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8432
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Country | US
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Telephone | 904-202-7300
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Fax | 904-202-2754
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Provider Business Mailing Address
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Address Line | PO BOX 746654
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City | ATLANTA
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State | GA
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Zip | 30374-6654
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D0066694
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 29646
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 0101050137
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 22983
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME142391
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License Number State | FL
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